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Active NPI 1255570099 Organization (Entity Type 2)

Custom Dme

Anaplastologist • Bountiful, UT

Public Directory Information & Medical Disclaimer

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About Custom Dme NPI 1255570099 Summary

Custom Dme is a verified healthcare organization specializing in Anaplastologist operating in Bountiful, UT. Located at 1455 S 500 W STE D, this facility provides patient care and medical services under National Provider Identifier (NPI) 1255570099.

Administrative operations and authorized compliance are overseen by Paul Tanner (Owner).

The facility is associated with 1 linked healthcare practitioner providing clinical services.

Facility Location & Contact Primary Location

Facility Address

1455 S 500 W Ste D

Bountiful, UT 840108252

Telephone 8019970545
Fax 8889775399

Authorized Official Information

Authorized Contact Name

Paul Tanner , CCA

Title / Role

Owner

Official Telephone

8019970545

Facility Classifications & Specialties

Anaplastologist Primary Taxonomy

NUCC Taxonomy Code: 229N00000X

An anaplastologist is a professional who creates prostheses for the face and body. Patients treated include those missing anatomy due to cancer, traumatic injury, or birth differences. Generally, there are no state licensing requirements for anaplastologists. Certification specific to anaplastology is provided through the Board for Certified Clinical Anaplastology (BCCA) with a credential title of Certified Clinical Anaplastologist (CCA).

Technician/Technologist - Ocularist

NUCC Taxonomy Code: 156FX1700X

An ocularist is a thoroughly trained professional skilled in the art of fitting, painting, and fabricating custom ocular prostheses. In addition to creating custom ocular prostheses, and providing long-term care through periodic examinations, an ocularist provides the patient with complete instructions on the care and maintenance of their prosthesis.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

1 Linked

Anaplastologist

Bountiful, UT

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

10 Historical Events
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Organization / Clinic Name Updated December 04, 2023

Operating as CUSTOM DME

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 04, 2023

Technician/Technologist

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Updated Practice Location November 06, 2023

Registered at 1455 S 500 W STE D, BOUNTIFUL, UT 840108252 (Tel: 8019970545)

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Medical Taxonomy / Specialty Registered (Primary Specialty) November 06, 2023

Anaplastologist

NPI Profile Active November 24, 2015

NPI status registered as active in NPPES database

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Updated Practice Location November 24, 2015

Registered at 3474 S 100 E, BOUNTIFUL, UT 840106605 (Tel: 8019970545)

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Updated Business Mailing Address November 24, 2015

Registered at 3474 S 100 E, BOUNTIFUL, UT 840106605 (Tel: 8019970545)

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Organization / Clinic Name Updated November 24, 2015

Operating as CUSTOM DME, LLC

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Medical Taxonomy / Specialty Registered (Primary Specialty) November 24, 2015

Durable Medical Equipment & Medical Supplies

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Initial NPI Registration & Enumeration February 18, 2009

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1255570099
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: February 18, 2009
Last Update: October 31, 2024

Mailing Address

3474 S 100 E

Bountiful, UT 840106605

Phone: 8019970545

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.